Annual meeting of the Partners for Measles Advocacy Washington DC, 23-24 September 2008

1. Annual meeting of the Partners for Measles AdvocacyWashington DC, 23-24 September 2008 Expanding the benefit through integrationDeworming update Albis Francesco GABRIELLIMedical OfficerPreventive Chemotherapy and Transmission ControlDepartment of Control of Neglected Tropical DiseasesHeadquarters, Geneva

2. Overview of the presentation • Introductions to helminths and their control • Reasons for including deworming in immunization interventions • Precautions when deworming very young children • Overview of what is happening worldwide

3. Introduction to helminth control • Preventive chemotherapy (PC) is the mainstay of the WHO-recommended strategy to control (and eliminate) helminth infections • PC is the large-scale distribution of anthelminthic drugs, at regular intervals, to population groups at-risk • Target diseases: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis • Goal: prevention of morbidity (+ reduction of transmission)

4. Integration • Since 2006 WHO stresses the need for "integration" in helminth control, with the aim of rationalising interventions and reducing costs • Integration among helminthic diseases: one drug is effective against more than a single disease, one disease can be treated with more than a single drug • Integration with other ongoing health interventions: seize all opportunities offered by existing "delivery channels"

5. Integration • Since 2006 WHO stresses the need for "integration" in helminth control, with the aim of rationalising interventions and reducing costs • Integration among helminthic diseases: one drug is effective against more than a single disease, one disease can be treated with more than a single drug • Integration with other ongoing health interventions: seize all opportunities offered by existing "delivery channels"

6. Delivery channels • School-based interventions • Community-based interventions • Routine health services (IMCI, etc.) • MCH interventions • Immunization campaigns (measles, polio) • Micronutrient supplementation activities • Insecticide treated nets (ITNs) distribution • Child Health Days/Weeks • Any combination of the above

7. Soil-transmitted helminthiasis (STH) • The most widespread disease worldwide (>2 billion people are infected): roundworm, whipworm, hookworm infections • Prevalence and intensity of infection peak in childhood • Severe impact on nutritional status (anaemia, micronutrient deficiencies), and on physical and intellectual development of children • 1 tablet of ALB or MBD given once or twice a year (deworming) "protects" children from risks associated with infection • ALB and MBD can be administered from the 1st birthday onwards

8. Including STH dewormingin immunization interventions • Logistics reason: • Overlapping of target populations • ALB/MBD are very cheap drugs (0.02 USD/tablet) • Popular and well-received drugs (flavoured, impact is visible) • Ease of administration • Scientific reasons (what immunization interventions can gain): • Deworming contributes to an effective immune response • Deworming increases vitamin A absorption RESULT: where deworming is co-delivered, an increase in vaccination coverage has been observed >> OR needed

9. Precautions when deworming young children (under 5s) The drugs are extremely safe: their administration must be equally safe, in order to avoid risk of choking on tablets • Use chewable tablets (better if flavoured) • Provide training on how to treat, how to handle children, what to do in case of choking • Administer drugs under supervision • Set the health post correctly: triage+registration>>vitamin A>>deworming tablet>>measles/injectable>>ITN • Crush tablets b/w two spoons, then add water (for children <3 years) • NEVER force a child !!!

10. STH deworming worldwide (2006) • 130 countries/territories endemic • PSAC: >82M treated / 386M at-risk (21.4%) in 51 countries • SAC: >77 M treated / 878M at-risk (8.8%) in 64 countries • In PSAC the high coverage, especially in the African Region, is …" a consequence of the inclusion of deworming activities in ongoing, well-organized, large-scale interventions with a strong monitoring system, such as immunization campaigns, micronutrient distribution interventions or mother and child health days"… Weekly Epidemiological Record 27/28, 2008, 83, 237-252

11. STH deworming worldwide (2006) • 27 countries including deworming into interventions delivering vaccines or vaccine-related products • Different combinations: • Vitamin A, deworming • Measles, deworming • OPV, deworming • OPV, vitamin A, deworming • ITN, measles, deworming • Vitamin A, iron, deworming • Measles, vitamin A, deworming • ITN, measles, vitamin A, deworming • >51M PSAC dewormed via the above interventions / 82M dewormed in total (62%) • >12M PSAC dewormed in interventions co-delivering measles vaccine (14.8% of those dewormed in total; 23.8% of those dewormed via any of the above interventions)

12. Documents & publications (I) Inclusion of deworming into existing delivery channels Helminth control strategy

13. Documents & publications (II) Deworming very young children Yearly progress report on numbers treated

14. Please visit our websites • The WHO Department of Control of Neglected Tropical Diseases: http://www.who.int/neglected_diseases/en/ • For documents and publications: http://www.who.int/wormcontrol/documents/en/ • For the newsletter "Action against Worms": http://www.who.int/neglected_diseases/preventive_chemotherapy/pctnewsletter/en/index.html

15. Thank you